Tractographie de la matière blanche orientée par a priori anatomiques et microstructurels = White matter tractography guided by anatomical and microstructural priors

Résumé : L'imagerie par résonance magnétique pondérée en diffusion est une modalité unique sensible aux mouvements microscopiques des molécules d'eau dans les tissus biologiques. Il est possible d'utiliser les caractéristiques de ce mouvement pour inférer la structure macroscopique des faisceaux de la matière blanche du cerveau. La technique, appelée tractographie, est devenue l'outil de choix pour étudier cette structure de façon non invasive. Par exemple, la tractographie est utilisée en planification neurochirurgicale et pour le suivi du développement de maladies neurodégénératives. Dans cette thèse, nous exposons certains des biais introduits lors de reconstructions par tractographie, et des méthodes sont proposées pour les réduire. D'abord, nous utilisons des connaissances anatomiques a priori pour orienter la reconstruction. Ainsi, nous montrons que l'information anatomique sur la nature des tissus permet d'estimer des faisceaux anatomiquement plausibles et de réduire les biais dans l'estimation de structures complexes de la matière blanche. Ensuite, nous utilisons des connaissances microstructurelles a priori dans la reconstruction, afin de permettre à la tractographie de suivre le mouvement des molécules d'eau non seulement le long des faisceaux, mais aussi dans des milieux microstructurels spécifiques. La tractographie peut ainsi distinguer différents faisceaux, réduire les erreurs de reconstruction et permettre l'étude de la microstructure le long de la matière blanche. Somme toute, nous montrons que l'utilisation de connaissances anatomiques et microstructurelles a priori, en tractographie, augmente l'exactitude des reconstructions de la matière blanche du cerveau.

Assurance qualité en dissection virtuelle des faisceaux de la matière blanche par tractographie

Ce mémoire est divisé en quatre chapitres. D’abord, une introduction initie le lecteur au domaine des neurosciences. Ensuite, le chapitre 1 décrit les étapes de la dissection virtuelle par tractographie, à partir du phénomène physique de la diffusion jusqu’aux mesures statistiques des structures de la matière blanche. Le chapitre 2 présentera une nouvelle méthode d’assurance qualité, basée sur l’analyse volumique des faisceaux de la matière blanche, la contribution principale de ce mémoire. Finalement, la conclusion contient une discussion des problématiques non résolues ainsi que des perspectives d’avenir pour la tractographie.

Eros y Tánatos en la teatralidad de Blanche Dubois en A streetcar named desire, de Tenesee Williams

Para elaborar una investigación sobre Eros y Tánatos en el personaje de Tennessee Williams de A Streetcar Named Desire, Blanche DuBois, es necesario hablar sobre la senda de destrucción que el personaje principal de la obra desarrolla de principio a fin. He basado mi estudio en la obra de Tennessee Williams como mi mayor referente. Además, he empleado también las obras de filósofos y psicoanalistas, tales como Freud, Lacan, Sartre, Foucault y Žižek, entre otros, porque ofrecían una visión muy parecida a la perspectiva de Williams. También he definido las teorías de mujeres tales como Helen Cixous, Judith Butler, Teresa de Lauretis y Camille Plagia, con visiones a veces muy distintas. Williams hace uso de su propia vida y de la de su hermana para explorar la esencia de sus personajes. Rose, su hermana, inspira el personaje de Blanche DuBois, ya que Williams está obsesionado con la enfermedad mental de Rose. Las repeticiones de Blanche, como sus baños de agua caliente o de “La Varsoviana”, la música que sonaba en el momento en que Allan, su joven marido se suicida, la falta de luz en su cara, etc., enuncian la tortura en la que ella vive. Blanche vive en un mundo de ilusiones en el que pretende que los que la rodean entren, pero nadie entra en su juego. Ella misma se acerca a Tánatos, el dios de la muerte no violenta. El pánico de Williams no es solamente sobre su hermana, sino sobre el hecho de que él puede volverse tan enfermo como Rose. Tanto Rose como Blanche son un peligro para el statu quo de la familia, y ambas deben ser eliminadas. El metateatro de Blanche se duplica, porque tiene dos públicos, el público que asiste al teatro para ver la obra y el público que la rodea en escena, como, por ejemplo, Stella, Stanley y Mitch, entre otros...

Genetics of Healthy Aging in Europe.The EU-Integrated Project GEHA (GEnetics of Healthy Aging)

The aim of the 5-year European Union (EU)-Integrated Project GEnetics of Healthy Aging (GEHA), constituted by 25 partners (24 from Europe plus the Beijing Genomics Institute from China), is to identify genes involved in healthy aging and longevity, which allow individuals to survive to advanced old age in good cognitive and physical function and in the absence of major age-related diseases. To achieve this aim a coherent, tightly integrated program of research that unites demographers, geriatricians, geneticists, genetic epidemiologists, molecular biologists, bioinfomaticians, and statisticians has been set up. The working plan is to: (a) collect DNA and information on the health status from an unprecedented number of long-lived 90+ sibpairs (n = 2650) and of younger ethnically matched controls (n = 2650) from 11 European countries; (b) perform a genome-wide linkage scannning in all the sibpairs (a total of 5300 individuals); this investigation will be followed by linkage disequilibrium mapping (LD mapping) of the candidate chromosomal regions; (c) study in cases (i.e., the 2650 probands of the sibpairs) and controls (2650 younger people), genomic regions (chromosome 4, D4S1564, chromosome 11, 11.p15.5) which were identified in previous studies as possible candidates to harbor longevity genes; (d) genotype all recruited subjects for apoE polymorphisms; and (e) genotype all recruited subjects for inherited as well as epigenetic variability of the mitochondrial DNA (mtDNA). The genetic analysis will be performed by 9 high-throughput platforms, within the framework of centralized databases for phenotypic, genetic, and mtDNA data. Additional advanced approaches (bioinformatics, advanced statistics, mathematical modeling, functional genomics and proteomics, molecular biology, molecular genetics) are envisaged to identify the gene variant(s) of interest. The experimental design will also allow (a) to identify gender-specific genes involved in healthy aging and longevity in women and men stratified for ethnic and geographic origin and apoE genotype; (b) to perform a longitudinal survival study to assess the impact of the identified genetic loci on 90+ people mortality; and (c) to develop mathematical and statistical models capable of combining genetic data with demographic characteristics, health status, socioeconomic factors, lifestyle habits.

Design, recruitment, logistics, and data management of the GEHA (Genetics of Healthy Ageing) project

In 2004, the integrated European project GEHA (Genetics of Healthy Ageing) was initiated with the aim of identifying genes involved in healthy ageing and longevity. The first step in the project was the recruitment of more than 2500 pairs of siblings aged 90 years or more together with one younger control person from 15 areas in 11 European countries through a coordinated and standardised effort. A biological sample, preferably a blood sample, was collected from each participant, and basic physical and cognitive measures were obtained together with information about health, life style, and family composition. From 2004 to 2008 a total of 2535 families comprising 5319 nonagenarian siblings were identified and included in the project. In addition, 2548 younger control persons aged 50-75 years were recruited. A total of 2249 complete trios with blood samples from at least two old siblings and the younger control were formed and are available for genetic analyses (e.g. linkage studies and genome-wide association studies). Mortality follow-up improves the possibility of identifying families with the most extreme longevity phenotypes. With a mean follow-up time of 3.7 years the number of families with all participating siblings aged 95 years or more has increased by a factor of 5 to 750 families compared to when interviews were conducted. Thus, the GEHA project represents a unique source in the search for genes related to healthy ageing and longevity.

Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)

AIMS: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment.

METHODS AND RESULTS: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries.

CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.